Abstract
Objective: Analysis of anaesthetic techniques in the extremely low weight infants, 1998-2003. Establishing the optimum general anaesthetic technique.
Design:Retrospective observational study. Setting:Dept. of Anaesthesia and Intensive Care, University Hospital, Prague, Dept. of Paediatric Surgery, Univer- sity Hospital, Prague.
Materials andMethods:Using the medical documentation of 118 paediatric patients (135 surgical procedures) weigh- ing less than 2,500 g on the day of surgery, we recorded the basic demographic data, surgical diagnoses and me- thods of general anaesthesia and/or neuromuscular blockade. Incidence of invasive anaesthetic procedures and the duration of surgical procedures were compared.
The resulting values were entered into tables, completed with per- centages when necessary and/or expressed as range of the highest/lowest values and average values. Results:While in the first year of the monitored period (1998) opioid-based anaesthesia supplemented with isoflu- rane dominated (48 %); in 2003 inhalational anaesthesia using sevoflurane supplemented with sufentanil was used in 90.3 % cases.
Vecuronium was replaced by atracurium/cis-atracurium for neuromuscular blockade. The most frequent surgical diagnoses were oesophageal atresia with tracheo-oesofageal fistula, ileus, atresia of duodenum and abdominal wall closure defects.
During 1998-2003 the number of invasive anaesthetic procedures increased (central venous catheter 20-38 %, arterial cannula 4-48 %, epidural catheter 8-33 %). Conclusion:General anaesthesia with sevoflurane supplemented with sufentanil and cis-atracurium is the method of choice in the anaesthetic management of the newborns indicated for major surgical procedures.
It may be com- plemented with epidural analgesia, invasive arterial pressure monitoring and central venous catheterisation.